Monitoring system and evaluation method for insertion operation of endoscope

ABSTRACT

A monitoring system includes an endoscope shape detection apparatus configured to detect a shape of an insertion section of an endoscope and a movement detection apparatus configured to detect a movement of a hand that operates the endoscope.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation application of PCT/JP2020/018641filed on May 8, 2020 and claims benefit of Japanese Application No,2019-101321 filed in Japan on May 30, 2019, the entire contents of whichare incorporated herein by this reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates to a monitoring system and an evaluationmethod for insertion operation of an endoscope.

2. Description of the Related Art

An endoscope has been widely used in a medical field and the like.However, it is not easy to insert an insertion section of the endoscopeinto a subject. For example, a large intestine has a complicated shape(traveling path). An advanced technique is required for a doctor aboutoperation of the endoscope not to cause pain to a patient when insertingthe insertion section of the endoscope into the large intestine.

The doctor can insert the insertion section into the subject whilechecking a shape of the insertion section inserted into the subjectusing an endoscope shape acquisition apparatus that displays, in realtime, an insertion shape of the insertion section of the endoscope inthe subject. However, it cannot be determined only with the insertionshape whether insertion operation of the doctor is good or bad.

International Publication No. 2015/070866 proposes an apparatus forendoscopic examination that presents, about advancing speed, anadvancing direction, and a dead time of a selected point in theinsertion section, predetermined scores compared with scores of anexpert and monitors quality of an endoscopic examination.

SUMMARY OF THE INVENTION

A monitoring system according to an aspect of the present inventionincludes: a shape detection apparatus configured to detect a shape of aninsertion section of an endoscope; and a movement detection apparatusconfigured to detect a movement of a hand that operates the endoscope.

An evaluation method for insertion operation of an endoscope accordingto an aspect of the present invention includes: detecting, with a shapedetection apparatus, a shape in a subject of an insertion section of theendoscope inserted into the subject; detecting, with a movementdetection apparatus, at least one of a position or a posture, in athree-dimensional space, of a hand with which an operator operating theendoscope grips the insertion section; and calculating, with aprocessor, based on information outputted from the movement detectionapparatus and concerning at least one of the position or the posture inthe three-dimensional space of the hand, at least one parameter of amovement amount, moving speed, a turning angle, or turning speed of thehand and outputting, temporally in correlation with each other, the atleast one parameter and information outputted from the shape detectionapparatus and concerning an insertion shape of the insertion section.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a configuration diagram showing a configuration of anendoscope insertion training system according to an embodiment of thepresent invention;

FIG. 2 is a diagram showing an example of an insertion shape imagedisplayed based on insertion shape information from a shape calculationapparatus according to the embodiment of the present invention;

FIG. 3 is a perspective view of a marker apparatus attached to a wristof a right hand of a user according to the embodiment of the presentinvention;

FIG. 4 is a diagram for explaining disposition of four markers at a timewhen the marker apparatus is attached to the wrist according to theembodiment of the present invention;

FIG. 5 is a diagram for explaining a state in which a user stands on ananus side of a model and inserts an insertion section into the modelaccording to the embodiment of the present invention;

FIG. 6 is a diagram for explaining the insertion section, an image ofwhich is picked up by a second image pickup apparatus, according to theembodiment of the present invention;

FIG. 7 is a diagram for explaining a plurality of indicators provided onan outer circumferential surface of the insertion section according tothe embodiment of the present invention;

FIG. 8 is a block diagram showing an endoscope insertion operationevaluation apparatus and a plurality of image pickup apparatusesaccording to the embodiment of the present invention;

FIG. 9 is a block diagram showing a configuration of the endoscopeinsertion operation evaluation apparatus according to the embodiment ofthe present invention;

FIG. 10 is a flowchart showing an example of a flow of processing of aninsertion method recording program of the endoscope insertion operationevaluation apparatus according to the embodiment of the presentinvention;

FIG. 11 is a diagram showing an example of a data structure of data forevaluation according to the embodiment of the present invention;

FIG. 12 is a flowchart showing an example of a flow of processing of aninsertion method display program of the endoscope insertion operationevaluation apparatus according to the embodiment of the presentinvention;

FIG. 13 is a diagram showing an example of an image showing operationranges of right hands of designated two doctors according to theembodiment of the present invention;

FIG. 14 is a diagram showing another example of the image showing theoperation ranges of the right hands of the designated two doctorsaccording to the embodiment of the present invention;

FIG. 15 is a diagram showing an example of an image showing a graphshowing changes in an advance and retraction amount and a torsion amountof the insertion section according to the embodiment of the presentinvention;

FIG. 16 is a diagram showing an example of an image showing a movementof a hand and a change of an insertion shape according to the embodimentof the present invention;

FIG. 17 is a diagram for explaining a change of an insertion shape and achange of a hand of an animation displayed in two windows according tothe embodiment of the present invention;

FIG. 18 is a diagram showing an example of an image obtained bysuperimposing an insertion shape on an image of the model, the imagebeing displayed in a window, according to the embodiment of the presentinvention;

FIG. 19 is a diagram for explaining disposition of a force gaugefunctioning as an amount of force sensor according to the embodiment ofthe present invention; and

FIG. 20 is a diagram showing an example of an image showing a graphshowing a change in an amount of force applied to the model according tothe embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

An embodiment of the present invention is explained below with referenceto the drawings.

FIG. 1 is a configuration diagram showing a configuration of amonitoring system according to the present embodiment. The monitoringsystem mainly includes an endoscope insertion training system(hereinafter simply referred to as training system) 1. The trainingsystem 1 includes an endoscope apparatus 2, an endoscope shapeacquisition apparatus 3, and an endoscope insertion operation evaluationapparatus 4. The endoscope apparatus 2, the endoscope shape acquisitionapparatus 3, and the endoscope insertion operation evaluation apparatus4 are disposed near a partial model (hereinafter referred to as model)102 of a human body fixed on a table 101. The model 102 is a colonmodel. The model 102 includes a main body section 102 a simulating ahuman body shape and includes, in the main body section 102 a, anintestinal tract section 102 b simulating a large intestine and an anussection 102 c simulating an anus. An inside of the intestinal tractsection 102 b communicates with the anus section 102 c.

The endoscope apparatus 2 includes an endoscope 6, an light sourceapparatus 7, an image processing apparatus 8, and a display apparatus 9.The light source apparatus 7, the image processing apparatus 8, and thedisplay apparatus 9 are placed on a cart 101 a or fixed to the cart 101a.

The endoscope 6 includes an insertion section 6 a, an operation section6 b, and a universal cord 6 c. The insertion section 6 a includes adistal end portion 11, a bendable bending section 12, and a flexibletube section 13 in order from a distal end toward a proximal end. Thedistal end portion 11 is a distal end portion of the insertion section 6a, that is, a distal end portion of the endoscope 6 and is a distal endrigid portion (a distal end configuration portion). An objective opticalsystem and an image pickup device are incorporated in the distal endportion 11. Accordingly, the endoscope 6 includes the insertion section6 a to be inserted into a subject, that is, the model 102.

The bending section 12 includes a plurality of bending pieces and iscapable of bending in upward, downward, left, and right directionsaccording to operation on two bending operation knobs 14 of theoperation section 6 b. The flexible tube section 13 bends according toan external force. The two bending operation knobs 14 are insertedthrough the insertion section 6 a and tow and slack an operation wire inorder to bend the bending section 12. The flexible tube section 13 is atubular member that has flexibility and bends according to an externalforce.

In the insertion section 6 a, a plurality of magnetic sensors 6 d forthe endoscope shape acquisition apparatus 3 are disposed at apredetermined interval. Note that in the present embodiment, theplurality of magnetic sensors are disposed at an equal interval along acenter axis of the insertion section 6 a. However, the plurality ofmagnetic sensors may be disposed at a different interval according to apart where an insertion method is desired to be evaluated. For example,if the part where the insertion method is desired to be evaluated is asigmoid colon of a large intestine, the number of the plurality ofmagnetic sensors may be set larger in a distal end side portion of theinsertion section 6 a than in a proximal end side portion and aninterval between the magnetic sensors adjacent to each other may be setnarrower in the distal end side portion.

A connector is provided at a distal end of the universal cord 6 c. Theendoscope 6 is detachably connected to the light source apparatus 7 andthe image processing apparatus 8 by the connector. The endoscope 6 is anendoscope insertable into the large intestine. Further, although notshown in FIG. 1, a light guide is inserted through the universal cord 6c. The endoscope 6 is configured to emit, from a distal end of theinsertion section 6 a through the light guide, illumination lightemitted from the light source apparatus 7. Further, a plurality ofsignal lines for the plurality of magnetic sensors 6 d are insertedthrough the universal cord 6 c.

A doctor (hereinafter referred to as user) who desires to evaluateinsertion operation of an endoscope uses the training system. The usermoves a right hand RH gripping the insertion section 6 a in variousdirections. In a state in which the user grips the insertion section 6 awith the right hand RH, the user pushes the insertion section 6 a intothe large intestine of the model 102 in an axial direction of theinsertion section 6 a and pulls out the insertion section 6 a from thelarge intestine. Further, in the state in which the user grips theinsertion section 6 a with the right hand RH, the user turns theinsertion section 6 a around an axis of the insertion section 6 a.

The image processing apparatus 8 receives an image pickup signaltransmitted from the image pickup device disposed at the distal endportion 11 of the insertion section 6 a, applies predetermined imageprocessing to the image pickup signal, and generates an endoscopicimage. The image processing apparatus 8 is connected to the displayapparatus 9 by a not-shown signal line. An image signal of theendoscopic image is outputted to the display apparatus 9. The endoscopicimage is displayed on a display screen of the display apparatus 9.

The endoscope shape acquisition apparatus 3 includes a shape calculationapparatus 21 and a magnetic field generation apparatus 22. The shapecalculation apparatus 21 is placed on the cart 101 a. The magnetic fieldgeneration apparatus 22 is placed on the table 101. The shapecalculation apparatus 21 is connected to the image processing apparatus8 by a not-shown signal line. The shape calculation apparatus 21receives, through the image processing apparatus 8, signals of theplurality of magnetic sensors 6 d incorporated in the endoscope 6. Theshape calculation apparatus 21 is connected to the magnetic fieldgeneration apparatus 22 by a signal line 23.

The magnetic field generation apparatus 22 generates a predeterminedmagnetic field based on a driving signal transmitted from the shapecalculation apparatus 21. The respective magnetic sensors 6 d detect themagnetic field generated by the magnetic field generation apparatus 22.Detection signals of the magnetic field transmitted from the pluralityof magnetic sensors 6 d are supplied to the shape calculation apparatus21. Note that a plurality of magnetic field generation elements may beprovided in the insertion section 6 a instead of the plurality ofmagnetic sensors 6 d. A magnetic sensor may be provided on an outside ofthe model 102 instead of the magnetic field generation apparatus 22 todetect positions and postures of the respective magnetic fieldgeneration elements.

The shape calculation apparatus 21 calculates a shape of the insertionsection 6 a in real time based on signals transmitted from therespective magnetic sensors 6 d. The shape calculation apparatus 21 isconnected to an endoscope insertion operation evaluation processor 33explained below by a signal line 21 a. Information about an insertionshape of the insertion section 6 a calculated by the shape calculationapparatus 21 is outputted to the endoscope insertion operationevaluation processor 33. The endoscope insertion operation evaluationprocessor 33 is capable of generating, based on the received informationabout the insertion shape, an insertion shape image viewed in adesignated visual point direction and displaying the insertion shapeimage on a display apparatus 34. Accordingly, the shape calculationapparatus 21 configures a shape detection apparatus that detects theinsertion shape of the insertion section 6 a.

FIG. 2 is a diagram showing an example of an insertion shape imagedisplayed based on insertion shape information outputted from the shapecalculation apparatus 21. FIG. 2 shows an insertion shape IPF of theinsertion section 6 a displayed in one window W on a display screen 34 aof the display apparatus 34. However, the insertion shape IPF can alsobe superimposed on another image and displayed by a software program inthe endoscope insertion operation evaluation processor 33.

Referring back to FIG. 1, the endoscope insertion operation evaluationapparatus 4 includes a first image pickup apparatus 31, a second imagepickup apparatus 32, the endoscope insertion operation evaluationprocessor 33, the display apparatus 34, an input apparatus 35, and abird's eye view camera 36. The input apparatus 35 includes a keyboard 35a and a mouse 35 b.

The first image pickup apparatus 31 is fixed to a frame 101 c fixed to atable 101 b. The second image pickup apparatus 32 is fixed on the table101. The endoscope insertion operation evaluation processor 33 is placedon the table 101 b.

The first image pickup apparatus 31 includes a plurality of cameras 31a. The plurality of cameras 31 a pick up, from right and obliquely aboveof the user, an image of an operation state in which the user operatesthe insertion section 6 a of the endoscope 6 and inserts the insertionsection 6 a into the model 102. Therefore, the plurality of cameras 31 acan pick up an image of the right hand RH of the user.

In the present embodiment, a movement of the right hand RH of the useris detected by infrared-type motion capture. More specifically, a markerapparatus 51 for motion capture is attached to the wrist of the righthand of the user. The respective cameras 31 a, which are infraredcameras, pick up images of the marker apparatus 51. A movement of theright hand of the user is detected based on movements of respectivemarkers 54 in the images obtained by picking up the images of the markerapparatus 51 with the respective cameras 31 a. A position and a postureof the right hand is detected. In other words, a three-dimensionalposition and a three-dimensional posture of the marker apparatus 51 aretime-sequentially acquired. A behavior of the right hand RH of the useris detected.

FIG. 3 is a perspective view of the marker apparatus 51 attached to thewrist of the right hand RH of the user. The marker apparatus 51 includesa band 52, a main body 53, a plurality of spherical markers 54, and aplurality of shaft members 55. The band 52 has elasticity for attachingand fixing the band 52 to the wrist. The hand 52 is belt-like, includesnot-shown fixing means, for example, a hook-and-loop fastener, and isdetachably attached to the wrist. The main body 53 is fixed on a surfaceof the band 52 by an adhesive, a screw, or the like. A plurality of,that is, four shaft members 55 are fixed to the main body 53 to projectfrom the main body 53. In other words, the marker apparatus 51 includesa plurality of markers 54 and is configured to be attached to the wristof the hand of the user, who is an operator who operates the insertionsection 6 a.

FIG. 4 is a diagram for explaining disposition of the four markers 54 ata time when the marker apparatus 51 is attached to the wrist. FIG. 5 isa diagram for explaining a state in which a user DU stands on the anussection 102 c side of the model 102 and inserts the insertion section 6a into the model 102. As shown in FIG. 5, in a state in which the markerapparatus 51 is attached to the wrist of the right hand RH, the user DUgrips the insertion section 6 a with the right hand RH and performs pushand pull and twisting operation of the insertion section 6 a.

In a state in which the user grips the insertion section 6 a with theright hand RU, the right hand RH is turned in a range of approximately+90 degrees to approximately −90 degrees around a longitudinal axis COof a right arm RA. The first image pickup apparatus 31 picks up an imageof the right hand RH of the user substantially from above. Accordingly,the marker apparatus 51 is attached to the wrist of the right hand RHsuch that the main body 53 is located in a position extended from athumb of the right hand RH toward a radius RB through a first metacarpalMB when viewed in an image pickup direction of the first image pickupapparatus 31.

The respective markers 54 are attached to distal ends of the shaftmembers 55 extending from the main body 53. In a state in which themarker apparatus 51 is attached to the wrist of the right hand RH, thefour markers 54 are located in a direction orthogonal to a plane PLformed by the image pickup direction of the first image pickup apparatus31 and the longitudinal axis CO of the right arm RA of the right handRH. The four markers 54 are disposed such that, when the image pickupapparatus 31 is picking up an image of a state in which the wrist of theright hand RH is not turning, a pair of markers 54 are located on bothsides of the longitudinal axis CO. The four markers 54 are disposed suchthat, when an image of the wrist is picked up from the thumb side, twoof the four markers 54 are located on one side with respect to thelongitudinal axis CO of the right arm RA and the other two markers 54are located on the other side with respect to the longitudinal axis COof the right arm RA.

Further, when the right hand RH turns around the longitudinal axis CO ofthe right arm RA, if the four markers 54 are immediately shadowed by theright arm RA, images of the respective markers 54 cannot be picked up bythe image pickup apparatus 31. Therefore, as shown in FIG. 4, a distanceLm between center points of the two markers 54 disposed across thelongitudinal axis CO is larger than a maximum outer diameter Wm (FIG. 3)of the right arm RA. The four markers 54 are disposed such that imagesof at least three of the four markers 54 are picked up by the imagepickup apparatus 31 irrespective of how the arm turns. Two or more ofcombinations of at least two markers 54 among the plurality of markers54 are disposed to be separated by 80 mm or more to make it possible todetect, with any one of the plurality of cameras 31 a, a state in whichthe plurality of makers 54 project from the wrist. As an example, two ormore combinations of the two markers 54 are disposed to be separated by80 mm or more and 100 mm or less.

The first image pickup apparatus 31 includes the plurality of cameras 31a that pick up images of the plurality of markers 54 in a plurality ofdirections in a three-dimensional space. The first image pickupapparatus 31 is located above a position of the right hand RH of theuser and on a right side or in a front of the user. Six cameras 31 a ofthe image pickup apparatus 31 pick up images of the right hand RH of theuser in different directions. The marker apparatus 51 moves according toa movement of the right hand RH. However, the image pickup apparatus 31is set to pick up an image within a range in which the marker apparatus51 moves at a normal insertion operation time.

As explained below, by such disposition of the four markers 54, variouskinds of operation including insertion operation of the insertionsection 6 a by the user, more specifically, twisting operation of theright hand RH are detected by picking up images of the various kinds ofoperation with the image pickup apparatus 31.

The second image pickup apparatus 32 is a camera that picks up an imageof a vicinity of the anus section 102 c from a side of the model 102. Ona surface of the insertion section 6 a to be inserted into an anus,characters and figures for detecting an insertion amount are provided byprinting or the like. The insertion section 6 a is sometimes operated byturning the operation section 6 b not only with the right hand RH butalso with a left hand. The second image pickup apparatus 32 is providedin order to detect a movement of the insertion section 6 a considering acase in which the insertion section 6 a is operated using not only theright hand RH but also the left hand. Accordingly, the second imagepickup apparatus 32 picks up an image of the insertion section 6 ainserted into the model 102, which is a subject.

FIG. 6 is a diagram for explaining the insertion section 6 a, an imageof which is picked up by the second image pickup apparatus 32. FIG. 7 isa diagram for explaining a plurality of indicators provided on an outercircumferential surface of the insertion section 6 a.

As shown in FIG. 6, the second image pickup apparatus 32 is fixed to thetable 101 to be able to pick up an image of the insertion section 6 ainserted into the anus section 102 c of the model 102. As indicated byan alternate long and short dash line in FIG. 6, the insertion section 6a inserted into the anus section 102 c is included in a range in whichan image is picked up by the image pickup apparatus 32.

As shown in FIG. 6 and FIG. 7, a plurality of indicators are provided onan outer surface of the insertion section 6 a by printing or the like. Aplurality of dotted lines 61 provided in a ring shape in acircumferential direction of the insertion section 6 a are disposed at apredetermined interval on the outer surface of the insertion section 6a. Further, as one indicator, a first character string 62 is disposed ina ring shape in the circumferential direction of the insertion section 6a. As another indicator, a second character string 63 is also disposedin a ring shape in the circumferential direction of the insertionsection 6 a.

Characters of the first character string 62 and characters of the secondcharacter string 63 are different. The characters of the first characterstring 62 are numbers or lower-case alphabets and the characters of thesecond character string 63 are upper-case alphabets. The characters ofthe first character string 62 and the second character string 63 areprinted such that the characters can be correctly read when theinsertion section 6 a is viewed with a distal end direction DD of theinsertion section 6 a directed upward and with a proximal end directionPD of the insertion section 6 a directed downward. The first characterstring 62 and the second character string 63 are provided between twodotted lines disposed in the circumferential direction of the insertionsection 6 a.

As still other indicators, a ring-like line 64 drawing in thecircumferential direction of the insertion section 6 a and a spiral line65 on the outer circumferential surface of the insertion section 6 a areprovided between the first character string 62 and the second characterstring 63. When viewed in a direction orthogonal to the longitudinalaxis of the insertion section 6 a, the spiral line 65 is drawn on theouter circumferential surface of the insertion section 6 a at 360degrees around the longitudinal axis to be inclined at a predeterminedangle with respect to the longitudinal axis of the insertion section 6a. In other words, a predetermined indicator 66 provided on the outersurface of the insertion section 6 a includes the line 64, which is afirst band annularly surrounding an outer circumference of the insertionsection 6 a in the direction orthogonal to the longitudinal axis of theinsertion section 6 a, and the line 65, which is a second band providedto be tilted with respect to the line 64 and spirally surrounding theouter circumference of the insertion section 6 a.

Even if the insertion section 6 a turns around the longitudinal axis, aposition of the line 64, an image of which is picked up by the imagepickup apparatus 32, does not change in the image obtained by the imagepickup apparatus 32. On the other hand, when the insertion section 6 aturns around the longitudinal axis, a position of the line 65, an imageof which is picked up by the image pickup apparatus 32, changes in theimage obtained by the image pickup apparatus 32.

Further, as shown in FIG. 7, a plurality of spiral lines 65 are drawn inthe same phase. In other words, positions of start points and positionsof end points of the spiral lines 65 in a plurality of predeterminedindicators 66 are respectively located on imaginary lines on the outercircumferential surface of the insertion section 6 a parallel to thelongitudinal axis.

The first and second character strings 62 and 63 and the lines 64 and 65are included in one predetermined indicator 66 and disposed inpredetermined positions between two dotted lines 61. The plurality ofpredetermined indicators 66 are drawn in the insertion section 6 a to beseparated from one another by a predetermined distance. Thepredetermined distance is, for example, 10 cm. Accordingly, a distancebetween two lines 64 adjacent to each other is the same as thepredetermined distance. The image pickup apparatus 32 is set such thatone predetermined indicator 66 is always included in the range in whichan image is picked up by the image pickup apparatus 32.

The first and second character strings 62 and 63 are recognized bycharacter recognition processing in the image obtained by the imagepickup apparatus 32. An insertion amount of the insertion section 6 ainto the large intestine is calculated based on recognized charactersand positions of the characters. Note that the two character strings 62and 63 are used to make it possible to, even if the characters of one ofthe character strings 62 and 63 are hidden by a hand, read thecharacters of the other.

As explained below, in the image obtained by the image pickup apparatus32, a torsion amount, that is, a torsion angle is calculated based on adistance between the two lines 64 and 65 in the respective predeterminedindicators 66. More specifically, the torsion amount is calculatedaccording to a ratio of length L1 of the line 64 and length L2 betweenthe lines 64 and 65 in the image obtained by the image pickup apparatus32. In FIG. 6, the length L2 is a distance (a longer distance) betweenan end portion of the line 64 and an end portion of the line 65 of theinsertion section 6 a. Note that in FIG. 6, as the distance between theend portion of the line 64 and the end portion of the line 65, there aretwo distances. The distance is a longer distance L2. However, a shorterdistance L3 may be used. The torsion amount is calculated according tothe ratio of the length L1 of the line 64 and the length L2 between thelines 64 and 65 in order to accurately calculate the torsion amount evenif a distance between the insertion section 6 a and the image pickupapparatus 32 changes.

The bird's eye view camera 36 is a third image pickup apparatus that isdisposed above the model 102 and picks up an image of the intestinaltract section 102 b of the model 102. An image pickup signal of thebird's eye view camera 36 is outputted to the endoscope insertionoperation evaluation processor 33.

FIG. 8 is a block diagram showing the endoscope insertion operationevaluation processor 33 and a plurality of image pickup apparatuses.FIG. 9 is a block diagram showing a configuration of the endoscopeinsertion operation evaluation processor 33.

The endoscope insertion operation evaluation processor 33 is connectedto the first image pickup apparatus 31, the second image pickupapparatus 32, the bird's eye view camera 36, which is the third imagepickup apparatus that picks up an image of the model 102, and the shapecalculation apparatus 21. The endoscope insertion operation evaluationprocessor 33 performs an arithmetic operation explained below andgenerates display data on the display apparatus 34.

As shown in FIG. 9, the endoscope insertion operation evaluationprocessor 33 is a processor including a central processing unit(hereinafter referred to as CPU) 71, a ROM 72, a RAM 73, a hard diskdevice (hereinafter referred to as HDD) 74, and various interfacecircuits (hereinafter referred to as I/Fs) 75, 76, 77, 78, 79, and 80.The CPU 71, the ROM 72, the RAM 73, the HDD 74, and the various I/Fs 75,76, 77, 78, 79, and 80 are connected to one another by a bus 81.

The I/F 75 is an interface between the respective cameras 31 a of thefirst image pickup apparatus 31 and the bus 81. The I/F 76 is aninterface between the second image pickup apparatus 32 and the bus 81.The I/F 77 is an interface between the bird's eye view camera 36 and thebus 81. The I/F 78 is an interface between the shape calculationapparatus 21 and the bus 81. The I/F 79 is an interface between thedisplay apparatus 34 and the bus 81. The I/F 80 is an interface betweenthe input apparatus 35 and the bus 81.

The HDD 74 includes a storage region 74 a that stores an insertionoperation evaluation program EP, a storage region 74 b that stores datafor evaluation ED, a storage region 74 c that stores a motion captureprogram MC, and a storage region 74 d that stores an animationgeneration program AP. The insertion operation evaluation program EPincludes an insertion operation recording program EP1 and an insertionoperation display program EP2.

The motion capture program MC is software for detecting positions of theplurality of markers 54 in a plurality of images obtained by theplurality of cameras 31 a and calculating a position and a posture, in athree-dimensional space, of the right hand RH to which the markerapparatus 51 is attached. Accordingly, the CPU 71 that executes themotion capture program MC configures a movement detection apparatus thatdetects a movement including a position and a posture, in athree-dimensional space, of a hand with which the user operating theendoscope 6 grips the insertion section 6 a. In particular, the movementdetection apparatus is a motion capture apparatus including the firstimage pickup apparatus 31 that picks up an image of the marker apparatus51 attached to the hand of the user, the motion capture apparatusdetecting a movement of the hand from a movement of the marker apparatus51, the image of which is picked up by the first image pickup apparatus31.

The animation generation program AP is software for generating ananimation image of a movement of the right hand RH from information ofthe position and the posture of the right hand RH calculated by themotion capture program MC. Processing of the insertion operationevaluation program EP and a data structure of the data for evaluation EDare explained below.

The CPU 71 can acquire, through the I/F 75, image pickup signalstransmitted from the respective cameras 31 a. Similarly, the CPU 71 canacquire, through the I/Fs 76 and 77, image pickup signals transmittedfrom the second image pickup apparatus 32 and the bird's eye view camera36. The CPU 71 can output generated display data to the displayapparatus 34 through the I/F 79.

The CPU 71 reads out the insertion operation evaluation program EP fromthe HDD 74 and executes the insertion operation evaluation program EP tothereby generate data such as a movement of the hand of the user andrecords the data for evaluation ED. Further, the CPU 71 can generatedisplay data for evaluation using the data for evaluation ED.

(Action)

Subsequently, the operation of the endoscope insertion operationevaluation processor 33 is explained.

Processing for calculating, recording, and outputting movementinformation of the right hand RH, shape information of the insertionshape IPF, and movement information and image information of theinsertion section 6 a in the endoscope insertion operation evaluationprocessor 33 is performed by the insertion operation evaluation programEP, the motion capture program MC, and the animation generation programAP. The programs are recorded in the ROM 72 or the HDD 74 as explainedabove. The CPU 71 reads out the programs, develops the programs in theRAM 73, and executes the programs, whereby functions such as detectionare realized.

(1) Recording

FIG. 10 is a flowchart showing an example of a flow of processing of theinsertion operation recording program EP1 of the endoscope insertionoperation evaluation processor 33. The CPU 71 reads out the insertionoperation recording program EP1 from the FWD 74, develops the insertionoperation recording program EP1 in the RAM 73, and executes theinsertion operation recording program EP1.

The CPU 71 acquires image pickup signals from the respective cameras 31a of the first image pickup apparatus 31 and calculates a position, aposture, and a torsion amount in the three-dimensional space of theright hand RH (step (hereinafter abbreviated a S) 1). More specifically,the CPU 71 calculates, based on positions in an image of the respectivemarkers 54 of the marker apparatus 51, with the motion capture programMC, a position (x, y, z) and a posture (vx, vy, vz) in thethree-dimensional space of the right hand. RH functioning as a rigidbody: vx, vy, and vz respectively indicate directions of referencevectors of x, y, and z axes of the right hand RH functioning as therigid body with respect to x, y, and z axes of the three-dimensionalspace. The CPU 71 calculates a torsion amount (r) of the right hand RHas well from the calculated position and the calculated posture. Thetorsion amount (r) is information indicating a turning angle around thelongitudinal axis CO of the right arm RA. In this way, the CPU 71generates information of the position, the posture, and the torsionamount in the three-dimensional space of the right hand RH.

The CPU 71 calculates a movement amount (AM), moving speed (SM), aturning angle (AR), and turning speed (SR) of the right hand RH from theinformation of the position, the posture, and the torsion amount of theright hand RH calculated in S1 (S2). More specifically, the CPU 71calculates the movement amount (AM) of the right hand RH in an insertingdirection of the insertion section 6 a from the information of theposition and the posture of the right hand RH calculated in S1. Themovement amount (AM) is a push and pull amount of the right hand RH inthe inserting direction of the insertion section 6 a. The CPU 71calculates the moving speed (SM) of the right hand RH in the insertingdirection of the insertion section 6 a from the information of theposition and the posture of the right hand RH calculated in S1. Themoving speed (SM) is speed of the right hand RH pushing and pulling theinsertion section 6 a. The CPU 71 calculates the turning angle (AR) ofthe right hand RH from the information of the torsion amount (r) of theright hand RH calculated in S1. The turning angle (AR) is an angle ofthe right hand RH functioning as the rigid body around the longitudinalaxis of the insertion section 6 a. The CPU 71 calculates the turningspeed (SR) of the right hand RH from the information of the torsionamount (r) of the right hand RH calculated in S1. The turning speed (SR)is angular velocity of turning of the right hand RH functioning as therigid body around the longitudinal axis of the insertion section 6 a.

The CPU 71 acquires an image pickup signal from the second image pickupapparatus 32 and calculates information of an insertion amount (L) and aturning amount (R) of the insertion section 6 a (53). More specifically,the CPU 71 generates an image from the image pickup signal of the imagepickup apparatus 32. The CPU 71 calculates the insertion amount (L) andthe turning amount (R) of the insertion section 6 a from the generatedpicked-up image and a position and a movement of characters or linesprovided on the outer surface of the insertion section 6 a.

Accordingly, as explained below, the CPU 71 calculates, based on thepicked-up image of the second image pickup apparatus 32, predeterminedparameters based on predetermined indicators provided on the outersurface of the insertion section 6 a, an image of which is picked up bythe second image pickup apparatus 32, and outputs the predeterminedparameters temporally in correlation with the information concerning theinsertion shape of the insertion section 6 a.

The CPU 71 acquires insertion shape information (SH) from the endoscopeshape acquisition apparatus 3 (S4). Further, the CPU 71 acquires animage pickup signal from the bird's eye view camera 36 and generates animage (S5). The CPU 71 links the information obtained in S1 to S5 withtime point information at the same time point and outputs theinformation as the data for evaluation ED of the HDD 74 (S6). The datafor evaluation ED is recorded in the HDD 74.

The processing in S1 to S6 is repeated at a predetermined period,whereby the data for evaluation is outputted. The respective kinds ofinformation obtained in S1 to S5 are linked with the time pointinformation. In other words, the endoscope insertion operationevaluation processor 33 is configured to calculate parameters of amovement amount, moving speed, a turning angle, and turning speed of thehand based on the information concerning the position and the posture inthe three-dimensional space of the hand and output the parameters andthe information concerning the insertion shape temporally in correlationwith each other.

FIG. 11 is a diagram showing an example of a data structure of the datafor evaluation ED. The data for evaluation ED is table data TBLincluding information such as a position, a posture, and a torsionamount as information concerning a movement of the right hand RH. Asexplained above, the information of the position (x, y, z), the posture(vx, vy, vz), and the torsion amount (r) of the right hand RH iscalculated by the motion capture program MC.

Further, the data for evaluation ED includes information of theinsertion amount (L) and the turning amount (R) as informationconcerning a movement of the insertion section 6 a. The insertion amount(L) is information calculated by character recognition of the firstcharacter string 62 and the second character string 63 on the outersurface of the insertion section 6 a in an image picked up by the imagepickup apparatus 32. The turning amount (R) is information calculatedbased on a distance between the two lines 64 and 65 on the outer surfaceof the insertion section 6 a in the image picked up by the image pickupapparatus 32.

The data for evaluation ED includes the shape information (SH) of theinsertion section 6 a. The shape information (SH) is informationoutputted from the shape calculation apparatus 21 and about theinsertion shape.

Further, the data for evaluation ED includes the image information (I)of the bird's eye view camera 36. The image information (I) isinformation of the image generated based on the image pickup signaltransmitted from the bird's eye view camera 36.

Note that the data for evaluation ED is one table data TBL shown in FIG.11. However, the data for evaluation ED may be configured from aplurality of table data.

The data for evaluation ED may not include all of the information shownin FIG. 11 and only has to include at least one piece of informationconcerning a movement of the hand.

(2) Display

FIG. 12 is a flowchart showing an example of a flow of processing of theinsertion operation display program EP2 of the endoscope insertionoperation evaluation processor 33. The CPU 71 reads out the insertionoperation display program EP2 from the HDD 74, develops the insertionoperation display program EP2 in the RAM 73, and executes the insertionoperation display program EP2. The endoscope insertion operationevaluation processor 33 is capable of generating a plurality of displayscreens for evaluating insertion operation. The user can operate theinput apparatus 35 and give a desired display command to the CPU 71. TheCPU 71 performs processing corresponding to the received displaycommand.

The CPU 71 determines whether the display command is instructed from theinput apparatus 35 by the user (S11). When the display command is notinstructed (S11: NO), the CPU 71 performs no processing. When thedisplay command is instructed (S11: YES), the CPU 71 generates displaydata corresponding to the display command (S12). The CPU 71 outputs thegenerated display data to the display apparatus 34 (S13).

Subsequently, an example of display data to be generated is explained.

1) Operation Range of a Hand

For example, the user sometimes desires to compare an operation range ofthe right hand at a time when the user inserts the insertion section 6 ainto the large intestine with operation ranges of other users. In thatcase, when the user inputs a predetermined command, an image shown inFIG. 13 is displayed on the display apparatus 34.

FIG. 13 is a diagram showing an example of an image showing operationranges of the right hand RH of the user and a designated another user.When the user desires to view a graph in which changes of positions ofthe right hands RH of the two doctors to be compared are plotted, theuser specifies the data for evaluation ED of the two doctors and inputsthe predetermined command. Then, a window DP1 in the display screen 34 ashown in FIG. 13 is displayed. FIG. 13 is a display example at a timewhen a user who is a resident, and an expert are selected as the twodoctors.

The window DP1 displays a graph showing a change of a position of theright hand RH at a time when the right hand RH of the user is viewedfrom above. A solid line indicates a trajectory of the right hand RH ofthe user, who is the resident. A dotted line indicates a trajectory ofthe right hand RH of the expert. Accordingly, trajectories of positionsof the right hands RH from an insertion start to removal in insertionoperation by the two doctors are indicated by the solid line and thedotted line. It is seen that a movement of the right hand RH of theresident is more wasteful compared with a movement of the right hand RHof the expert.

Like FIG. 13, FIG. 14 is a diagram showing another example of the imageshowing the operation ranges of the right hands RH of the designated twodoctors. A screen shown in FIG. 14 is displayed according to a commanddifferent from the command shown in FIG. 13.

A window DP2 shown in FIG. 14 displays a graph showing changes ofpositions of the right hands RH at a time when the model 102 is viewedfrom the anus section 102 c side. In FIG. 14 as well, it is seen that amovement of the right hand RH of the resident indicated by a solid lineis more wasteful compared with a movement of the right hand RH of theexpert indicated by a dotted line.

The respective graphs of FIG. 13 and FIG. 14 are drawn based oninformation of the position (x, y, z) of the movement of the hand in thetable data TBL shown in FIG. 11.

Note that the graphs of FIG. 13 and FIG. 14 may be displayed to begradually drawn according to elapse of time. For example, when thedrawing is started from a point of a time point t0 and graph drawing isperformed such that a line of the graph extends according to the elapseof time, it is easy to understand a movement of a hand of the usercorresponding to the elapse of time. In other words, the endoscopeinsertion operation evaluation processor 33 may output display data fordrawing, based on information of a position of the hand, the position ofthe hand as a graph according to the elapse of time.

2) An Advance and Retraction Amount and a Torsion Amount of theInsertion Section

For example, the user sometimes desires to view a change in an advanceand retraction amount (that is, push and pull) and a change in a torsionamount of the insertion section 6 a at a time when the insertion section6 a is inserted into the large intestine. In that case, when the userinputs a predetermined command, windows DP3 and DP4 are displayed on thedisplay screen 34 a shown in FIG. 15. FIG. 15 is a diagram showing anexample of an image showing a graph showing changes in an advance andretract amount and a torsion amount of the insertion section.

The window DP3 displays a graph showing the change in the advance andretraction amount (that is, push and pull) of the insertion section 6 a.The window DP4 displays a graph showing an example of an image showingthe change in the torsion amount of the insertion section 6 a. When theuser inputs the predetermined command, the image shown in FIG. 15 isdisplayed. In other words, the endoscope insertion operation evaluationprocessor 33 outputs first display data for displaying informationconcerning first parameters among a movement amount, moving speed, aturning angle, and turning speed of a hand within a first time periodand second display data for displaying information concerning secondparameters among the movement amount, the moving speed, the turningangle, and the turning speed of the hand within a second time period.

In FIG. 15, in the graph in the window DP3 and the graph in the windowDP4, time axes of the horizontal axes are aligned, that is,synchronized. A period from approximately 20 seconds to 70 seconds is atime period when the distal end portion 11 of the insertion section 6 ais passing through a sigmoid colon. A period from approximately 70seconds to 90 seconds is a time period when the distal end portion 11 ofthe insertion section 6 a is passing through a splenic flexure. A periodfrom approximately 90 seconds to 100 seconds is a time period when thedistal end portion 11 of the insertion section 6 a is passing through atransverse colon. Accordingly, the user can learn, viewing these graphs,a push and pull amount of the insertion section 6 a and a torsion amountof the insertion section 6 a.

For example, in the case of FIG. 15, it is shown that the insertionsection 6 a is twisted while being pulled between 60 seconds and 80seconds. Accordingly, when the user is the resident, if a push and pullamount of the insertion section 6 a and a torsion amount of theinsertion section 6 a of the expert are displayed, it is possible tocompares the push and pull amount of the expert with a push and pullamount and a torsion amount of the user and improve insertion operationof the user.

The respective graphs of FIG. 15 are drawn based on the information ofthe insertion amount (L) and the turning amount (R) of the insertionsection 6 a in the table data TBL in FIG. 11.

3) A Movement of the Hand and an Insertion Shape

For example, the user sometimes desires to view how an insertion shapeSR of the insertion section 6 a changes according to a movement of theright hand RH. In that case, when the user inputs a predeterminedcommand, windows DP5 and DP6 in the display screen 34 a shown in FIG. 16are displayed, FIG. 16 is a diagram showing an example of an imageshowing a movement of a hand and a change of an insertion shape.

The window DP5 displays the insertion shape IPF of the insertion section6 a. The window DP6 displays a movement of the right hand RH as ananimation. When the user inputs a predetermined command, the image shownin FIG. 16 is displayed.

An insertion shape of the insertion section 6 a is displayed in thewindow DP5. An animation image of the right hand is displayed in thewindow DP6. The animation generation program AP generates an animationimage of a movement of the right hand RH from information of a position(x, y, z) and a posture (vx, vy, vz) of the right hand RH. In otherwords, the endoscope insertion operation evaluation processor 33 outputsdisplay data for displaying, in synchronization with each other, aninsertion shape and an animation image of a hand generated based oninformation of a position and a posture of the hand.

FIG. 17 is a diagram for explaining a change of the insertion shapedisplayed in the window DP5 and a change of the hand of the animationdisplayed in the window DP6. FIG. 17 shows changes of imagescorresponding to elapse of time of the two windows DP5 and DP6. WindowsDP5 t and DP6 t show images at the same time point t, windows DP5(t+m)and DP6(t+m) show images at the same time point (t+m) elapsed from thetime point t, and windows DP5(t+n) and DP6(t+n) show images at the sametime point (t+n) elapsed from the time point (t+m).

As shown in FIG. 17, the insertion shape IPF of the insertion section 6a and a right hand RHa of an animation are displayed in the two windowsDP5 and DP6 shown in FIG. 16 in synchronization with each other.Accordingly, the user can learn how the insertion shape IPF of theinsertion section 6 a change according to a movement of the right handRH.

Unlike a rigid instrument, in a flexible endoscope such as a largeintestine endoscope, the insertion section 6 a of the endoscope 6 doesnot always operate in a one-to-one relation with operation of a doctor.For example, when the doctor pushes the endoscope 6 into a subject, insome case, the endoscope 6 bends in an intestinal tract and the distalend portion 11 of the endoscope 6 does not proceed to depth of theintestinal tract. In such a case, in general, a resident often cannotrecognize how the insertion section 6 a inserted into a body moves inresponse to endoscope operation of the resident. Therefore, for theresident, it is extremely important in learning insertion operation toknow how the insertion shape IPF of the insertion section 6 a changes inresponse to a movement of the right hand RH.

An image in the window DP5 shown in FIG. 16 is drawn based on shapeinformation in the table data TBL in FIG. 11. An image in the window DP6shown in FIG. 16 is created and drawn by the animation generationprogram AP based on the information of the position, the posture, andthe torsion amount during the movement of the hand in the table data TBLshown in FIG. 11. In particular, since the movement of the hand isdisplayed as an amination and the insertion shape of the insertionsection is displayed in synchronization, it is easy to understand themovement of the hand and the insertion shape of the insertion section.

Note that in FIG. 16, only the insertion shape IPF is displayed in thewindow DP5. However, an image obtained by superimposing the insertionshape IPF on an image of the model 102 picked up by the bird's eye viewcamera 36 may be displayed.

FIG. 18 is a diagram showing an example of the image obtained bysuperimposing the insertion shape IPF on the image of the model 102, theimage being displayed in the window DP5. With the image shown in FIG.18, the user can easily understand a state of the insertion section 6 ain the intestinal tract section 102 b.

Note that if the table data TBL explained above is used, various kindsof display can be performed other than the display examples explainedabove.

The endoscope insertion operation evaluation processor 33 may acquirevarious kinds of information from the endoscope apparatus 2 and generateand output display data including information concerning operation onthe endoscope apparatus 2 by the user. For example, when hardnessvariable operation for the insertion section 6 a is performed, ifdisplay data including information indicating that the hardness variableoperation is performed is generated, the user can evaluate the insertionoperation and the information concerning the operation on the endoscopeapparatus 2 in correlation with each other.

Furthermore, a position of the distal end portion 11 of the insertionsection 6 a may be estimated from shape information of the endoscopeshape acquisition apparatus 3. Display data including informationconcerning the estimated position may be generated and outputted. Basedon the position information of the distal end portion 11, a message suchas “passing through the sigmoid colon” can also be displayed on a graphdisplayed on the display apparatus 34.

Note that an amount of force sensor that can detect an amount of forceby operation of the user may be provided in the model 102. FIG. 19 is adiagram for explaining disposition of a force gauge functioning as theamount of force sensor. A force gauge 91 measures pushing and pullingforce. The force gauge 91 is provided on the table 101 such that asensor unit 91 a for amount of force detection of the force gauge 91comes into contact with a surface of the model 102 on an opposite sideof the anus section 102 c. A cable 92 for outputting a measurementsignal extends from the force gauge 91.

The model 102 is fixed on two linear guide rails 93 fixed on the table101. In other words, the model 102 functioning as a subject is mountedon the two linear guide rails 93, which are mounts that smoothly move ina predetermined range in a longitudinal direction in a direction inwhich the insertion section 6 a is inserted. The model 102 is fixed onthe linear guide rails 93 to move within the predetermined range on thelinear guide rails 93. The force gauge 91 is fixed to the table 101 suchthat the sensor unit 91 a of the force gauge 91 comes into contact withthe model 102. Note that the linear guide rails 93 may be one linearguide rail. The model 102 can be moved in the longitudinal direction bya method of, for example, rolling the model 102 with a roller ormagnetically levitating the model 102.

As shown in FIG. 19, an output of the force gauge 91 is outputted to theendoscope insertion operation evaluation processor 33 by the cable 92.The endoscope insertion operation evaluation processor 33 receives ameasurement signal of the force gauge 91. Accordingly, the force gauge91 configures an amount-of-force detecting unit that detects forceapplied to the model 102, which is the subject, or the insertion section6 a.

It is possible to detect an amount of force, that is, push and pullforce by operation of the insertion section 6 a by the user using theforce gauge 91 provided in this way. In other words, the force gauge 91detects force applied to the subject or the insertion section 6 a in thelongitudinal direction in the direction in which the insertion section 6a is inserted and a direction different from the longitudinal direction(an opposite direction). Note that the force gauge 91 may detect onlyforce in one of the longitudinal direction in the direction in which theinsertion section 6 a is inserted and the direction different from thelongitudinal direction (the opposite direction).

FIG. 20 is a diagram showing an example of an image showing a graphshowing a change in an amount of force applied to the model. Theendoscope insertion operation evaluation processor 33 outputsinformation concerning the force temporally in correlation withinformation concerning the insertion shape IPF. As a result, a graph ofa change in an amount of insertion force corresponding to elapse of timeis displayed in a window DP7. If the graph shown in FIG. 20 is arrangedin a pair as shown in FIG. 15, the user can easily learn a differencebetween amounts of insertion force of two doctors.

As explained above, with the embodiment explained above, it is possibleto provide a monitoring system and an evaluation method for insertionoperation of an endoscope that can present an endoscope insertionoperation method that can present how a hand gripping an insertionsection should be moved.

Note that as a sensor that can detect an amount of force for insertingthe insertion section 6 a into the model 102 with operation of the user,for example, a not-shown torque sensor that measures turning force on ahand side of the user (at which torque the user is twisting theinsertion section 6 a) may be further added other than the force gauge91 and information from the torque sensor may be added to a detectionresult.

Since the user can display desired display data using data forevaluation, the user can perform evaluation of insertion operation. Inparticular, since the movement information of the hand and the insertionshape information of the endoscope shape acquisition apparatus 3 arerecorded temporally in correlation with each other, the user can checkthe movement of the hand and the insertion shape of the insertionsection 6 a in correlation with each other.

Note that the embodiment explained above is explained as the endoscopeinsertion training system for training in the insertion operation of theendoscope. However, the embodiment is also applicable to a system notfor training but for simply evaluating the insertion operation.

As example of the embodiment explained above is the insertion operationof the endoscope into the model. However, the embodiment can also beused as an evaluation apparatus for insertion operation into a patientor the like.

Furthermore, in the present embodiment, a recording function, a displayfunction, and the like of the endoscope insertion operation evaluationprocessor 33 are executed by software. However, the respective functionsmay be configured as individual electronic circuits or may be configuredas circuit blocks in an integrated circuit such as an FPGA (fieldprogrammable gate array). In the present embodiment, for example, theendoscope insertion operation evaluation processor 33 may include one ormore CPUs.

The present invention is not limited to the embodiment explained above.Various changes, alterations, and the like are possible within a rangenot changing the gist of the invention.

What is claimed is:
 1. A monitoring system comprising: a shape detectionapparatus configured to detect a shape of an insertion section of anendoscope; and a movement detection apparatus configured to detect amovement of a hand that operates the endoscope.
 2. The monitoring systemaccording to claim 1, wherein the shape detection apparatus isconfigured to detect an insertion shape of the insertion section of theendoscope inserted into a subject, the movement detection apparatus isconfigured to detect a movement including at least one of a position ora posture, in a three-dimensional space, of the hand with which anoperator operating the endoscope grips the insertion section, and themonitoring system further comprises an endoscope operation evaluationapparatus including a processor configured to calculate, based oninformation outputted from the movement detection apparatus andconcerning the at least one of the position or the posture in thethree-dimensional space of the hand, at least one parameter of amovement amount, moving speed, a turning angle, or turning speed of thehand and output, temporally in correlation with each other, the at leastone parameter and information outputted from the shape detectionapparatus and concerning the insertion shape of the insertion section.3. The monitoring system according to claim 2, wherein the movementdetection apparatus is a motion capture apparatus including a firstimage pickup apparatus configured to pick up an image of a markerapparatus attached to the hand of the operator, the motion captureapparatus detecting a movement of the hand from a movement of the markerapparatus, the image of which is picked up by the first image pickupapparatus.
 4. The monitoring system according to claim 3, wherein themarker apparatus includes a plurality of markers and is configured to beattached to a wrist of the hand of the operator, and the first imagepickup apparatus includes a plurality of cameras configured to pick upimages of the plurality of markers in a plurality of directions in thethree-dimensional space.
 5. The monitoring system according to claim 4,wherein at least two markers among the plurality of markers are disposedto be separated by 80 mm or more to make it possible to detect, with anyone of the plurality of cameras, a state in which the plurality ofmarkers project from the wrist.
 6. The monitoring system according toclaim 3, further comprising a second image pickup apparatus configuredto pick up an image of the insertion section inserted into the subject,wherein the processor calculates, based on a picked-up image of thesecond image pickup apparatus, a predetermined parameter based on apredetermined indicator provided on an outer surface of the insertionsection, the image of which is picked up by the second image pickupapparatus, and outputs the predetermined parameter temporally incorrelation with the information concerning the insertion shape of theinsertion section.
 7. The monitoring system according to claim 6,wherein the predetermined indicator includes a first hand annularlysurrounding an outer circumference of the insertion section in adirection orthogonal to a longitudinal axis of the insertion section anda second hand provided to be tilted with respect to the first band andspirally surrounding the outer circumference of the insertion section.8. The monitoring system according to claim 2, further comprising aforce gauge configured to detect force applied to the subject or theinsertion section, wherein the processor outputs information concerningthe force temporally in correlation with the information concerning theinsertion shape.
 9. The monitoring system according to claim 8, whereinthe subject is mounted on a mount that moves in a predetermined range ina longitudinal direction in a direction in which the insertion sectionis inserted, and the force gauge detects force applied to the subject orthe insertion section in at least one of the longitudinal direction or adirection different from the longitudinal direction.
 10. The monitoringsystem according to claim 2, wherein the processor outputs first displaydata for displaying information concerning a first parameter among themovement amount, the moving speed, the turning angle, and the turningspeed of the hand within a first time period and second display data fordisplaying information concerning a second parameter among the movementamount, the moving speed, the turning angle, and the turning speed ofthe hand within a second time period.
 11. The monitoring systemaccording to claim 2, wherein the processor outputs display data fordisplaying, in synchronization with each other, the insertion shape andan animation image of the hand generated based on information of theposition and the posture.
 12. The monitoring system according to claim2, wherein the processor outputs, based on information of the positionin the three-dimensional space of the hand, display data for drawing theposition of the hand in a graph according to elapse of time.
 13. Anevaluation method for insertion operation of an endoscope, comprising:detecting, with a shape detection apparatus, an insertion shape in asubject of an insertion section of the endoscope inserted into thesubject; detecting, with a movement detection apparatus, at least one ofa position or a posture, in a three-dimensional space, of a hand withwhich an operator operating the endoscope grips the insertion section;and calculating, with a processor, based on information outputted fromthe movement detection apparatus and concerning at least one of theposition or the posture in the three-dimensional space of the hand, atleast one parameter of a movement amount, moving speed, a turning angle,or turning speed of the hand and outputting, temporally in correlationwith each other, the at least one parameter and information outputtedfrom the shape detection apparatus and concerning the insertion shape ofthe insertion section.